Pain Control With Caudal Epidural vs. Combined Caudal Epidural and Lumbar Sympathetic Block .

NCT ID: NCT07199816

Last Updated: 2025-09-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-01

Study Completion Date

2026-08-01

Brief Summary

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Comparing the analgesic effect of caudal epidural versus combined lumbar sympathetic block with caudal epidural in patients undergoing redo spinal surgery.

Detailed Description

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To evaluate the improvement in pain score using numerical rate scale (NRS) over 4 months and compare this between the two groups.

* To assess and compare the improvement of motor activity and early ambulation using EuroQo lmeasure (EQ-5D) between the two groups.
* To evaluate and compare the overall patient satisfaction between the two groups.

Conditions

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Pain Management After Surgery

Keywords

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pain control

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Caregivers

Study Groups

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Group C

Group C (n=32): this group will receive fluoroscopy guided caudal epidural block.

Under fluoroscopic guidance and the patients in prone position, caudal epidural injection will be achieved. A pillow will be inserted under the pelvic bones for better exposure and accessibility of thesacral hiatus. Betadine will be used for sterilization of the sacrococcygeal area and palpation of the coccygeal tip. Upon localization of the sacral hiatus, a 22-gauge, 3.5-inch length spinal needle (Spinocan®, BRAUN, Melsungen, Germany) with the image intensifier will be used to inject 1 mL of contrast media (Omnipaque 300; GE Healthcare, Carrigtohill, Co. Cork, Ireland). After confirming the right needle position and excluding intravascular, intrathecal, and soft tissue infiltration, 10 cc of the treatment drug (8 ml of 0.5%lidocaine mixed with 2ml of 8 mg dexamethasone) will be injected.

Group Type ACTIVE_COMPARATOR

Fluoroscopy-Guided Caudal Epidural Block

Intervention Type PROCEDURE

Under fluoroscopic guidance, the patient in the prone position will receive a caudal epidural injection through the sacral hiatus. A 22-gauge, 3.5-inch spinal needle (Spinocan®, BRAUN) is used to inject 1 mL of contrast media (Omnipaque 300) to confirm correct needle placement. Then, 10 mL of treatment solution (8 mL of 0.5% lidocaine and 2 mL of 8 mg dexamethasone) is administered.

Group LC

Group LC: Group (n=32): this group will receive combined fluoroscopy guided caudal epidural block and lumbar sympathetic ganglion block.

Under fluoroscopic guidance, LSGB will be performed. The block level and side will be determined. Patients will be kept in the prone position while C-arm (GE OEC 9900 C- of the anteroposterior, oblique, and lateral view are examined to verify the correct entrance sit. The skin will be prepared in an aseptic manner. Approach the anterolateral border of the inferior sec of the L2 vertebral body or the upper portion of the L3 vertebral body of the affected side where the pain exists, using a 21-gauge Chiba needle.

Following the confirmation of the needle location via fluoroscopic imaging, an aspiration test will be performed in order to rule out the presence of blood, following by injection of a contrast medium. Following that, 2 mL of 8mg dexamethasone will be diluted with 8 mL of 1% lidocaine and injected unilaterally at one level.

Group Type ACTIVE_COMPARATOR

Combined Lumbar Sympathetic Ganglion Block and Caudal Epidural Block

Intervention Type PROCEDURE

Patients will receive both a caudal epidural block and a lumbar sympathetic ganglion block (LSGB) under fluoroscopic guidance. The LSGB is performed at the L2 or L3 vertebral body on the affected side using a 21-gauge Chiba needle. After confirming needle position with contrast imaging, 10 mL of solution (2 mL of 8 mg dexamethasone + 8 mL of 1% lidocaine) is injected. A caudal block is then performed as described above.

Interventions

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Fluoroscopy-Guided Caudal Epidural Block

Under fluoroscopic guidance, the patient in the prone position will receive a caudal epidural injection through the sacral hiatus. A 22-gauge, 3.5-inch spinal needle (Spinocan®, BRAUN) is used to inject 1 mL of contrast media (Omnipaque 300) to confirm correct needle placement. Then, 10 mL of treatment solution (8 mL of 0.5% lidocaine and 2 mL of 8 mg dexamethasone) is administered.

Intervention Type PROCEDURE

Combined Lumbar Sympathetic Ganglion Block and Caudal Epidural Block

Patients will receive both a caudal epidural block and a lumbar sympathetic ganglion block (LSGB) under fluoroscopic guidance. The LSGB is performed at the L2 or L3 vertebral body on the affected side using a 21-gauge Chiba needle. After confirming needle position with contrast imaging, 10 mL of solution (2 mL of 8 mg dexamethasone + 8 mL of 1% lidocaine) is injected. A caudal block is then performed as described above.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age 40-70 years.
* Both sexes.
* American Society of Anesthesiologists (ASA) physical status I to III.
* Undergoing lumbar spine surgery level L4-5/ L5-S1 for the second time.
* Duration of chronic low back pain \> 3months.

Exclusion Criteria

* Emergency surgeries.
* Bleeding disorder.
* patient refusal for the procedure.
* Pregnancy.
* Neoplastic diseases, allergies to contrast.
* Liver failure or kidney failure .
Minimum Eligible Age

40 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role collaborator

Hebatullah Mohammed Abdelmageed

OTHER

Sponsor Role lead

Responsible Party

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Hebatullah Mohammed Abdelmageed

Hebatullah Mohammed Abdelmageed, Principle Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Kasr Al-Ainy Medical School, Cairo University

Cairo, , Egypt

Site Status

Countries

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Egypt

Related Links

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Other Identifiers

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N- 26- 2024/ MD

Identifier Type: -

Identifier Source: org_study_id